Provider Demographics
NPI:1841722873
Name:JDM COUNSELING SERVICES, LLC
Entity type:Organization
Organization Name:JDM COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING/CREDENTIALING SPEC.
Authorized Official - Prefix:
Authorized Official - First Name:TOMEKA
Authorized Official - Middle Name:C
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MBRS
Authorized Official - Phone:402-885-7672
Mailing Address - Street 1:11840 NICHOLAS ST STE 101
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-4475
Mailing Address - Country:US
Mailing Address - Phone:402-201-5684
Mailing Address - Fax:
Practice Address - Street 1:11840 NICHOLAS ST STE 101
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-4475
Practice Address - Country:US
Practice Address - Phone:402-201-5684
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-29
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEP-1393101YA0400X
NE4937101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty